CARE HOMES FOR OLDER PEOPLE
Walmer House 6 Ash Hill Road Torquay Devon TQ1 3HZ Lead Inspector
James Rose Announced 30th August 2005 and 2 February 2006
nd The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Walmer House Address 6 Ash Hill Road, Torquay, Devon, TQ1 3HX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 292734 01803 292734 Keychange Charity Vacant Care Home 17 Category(ies) of Old Age - not falling within any other category registration, with number (17), Dementia - over 65 years of age (17) of places Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 09/11/04 Brief Description of the Service: Walmer House is a large detached Victorian house which stands in its own grounds. The home provides 24-hour care for up to 17 persons who require care by reason of old age or dementia. Accommodation is provided in single rooms throughout, 14 bedrooms have on suite facilities available. A large comfortably furnished communal lounge is situated on the ground floor. Meals are taken in a dedicated dining room at small tables. A vertical lift is provided and appropriate aids for persons with mobility issues. At the front of the home there is a large off road parking area, to the side and rear of the building there is a well-tended garden with extensive views of the surrounding area. Walmer House is run as a Christian charity by Keychange. The home is situated approximately half a mile from the town centre of Torquay. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was undertaken over two visits, the first visit was completed on 30th August 2006 and the inspection was completed on 2nd February 2006 it took 6.5 hours in all. A complete tour of the home was undertaken and samples of the care records were examined. Six residents were consulted and one of their visitors. Two of the district nursing teams were also consulted that provide a service to the home. The inspection was undertaken with the assistance of the proposed registered manager and the operations controller; the inspector was accompanied by his regulation manager. What the service does well: What has improved since the last inspection? What they could do better:
The assessments of proposed residents and their care plans have been discussed in detail at the last two inspections and it has been agreed that all
Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 6 the needs of a person would be included to ensure that an appropriate service was provided for the individual concerned. The requirement for social needs to be included in assessment and care planning was an issue raised in the reports dated 24th August 2004 and 9th November 2004. There remain clear deficits in the assessment of residents at the home and in their care plans and requirements have been raised in this report to ensure that this is rectified. A date has been agreed for completion and the Commission should be contacted if this is not going to be achieved in order that the date can be renegotiated. Some risk assessments that should have been undertaken on hazards in the home were missing at the time of the inspection and subsequently residents’ were at risk. A requirement has been raised in this report for all hazards to be appropriately assessed to ensure residents are safe at all times. There were substantial gaps in the administration records of medication maintained by the home and a requirement has been raised to ensure all carers follow the policy and procedure in place. These issues were discussed and it has been agreed that the Commission will arrange for the home to have a visit from the pharmacy inspector to provided further advice. The proposed registered manager and the operations controller both said that they were asking staff to follow the policies and procedures in the home but this was not having the desired outcome. It is acknowledged that there have been staffing issues at the home for a long time but it is essential that carers are competent and follow the policies and procedure in place to ensure residents are safe. No recent formal staff supervision has been undertaken in the home recently and a requirement has been raised to ensure this is put in place. There were clear deficits in the personnel files in the home and a requirement has been raised to ensure these are addressed. When the accident record was examined in the home it was clear that some events that should have been reported were not. A requirement has been raised to ensure that this is undertaken in future. The proposed manager is active in making sure that the residents in the home are happy with the service provided but no recorded system is in place and no quality assurance system is in used to ensure carers follow appropriate procedures. The proposed registered manager needs to complete a detailed induction and further training. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 The assessments undertaken by the home of proposed residents had clear deficits and did not cover all the needs of the individual. EVIDENCE: Three assessments were examined at this inspection these had little or no social needs element. Under these conditions it would be difficult for the home to ensure that they provide an appropriate service. The need for a detailed assessment has been discussed at the last two inspections with the operations controller and the inspector has been assured that this would be addressed, unfortunately this has not been achieved and a requirement has been raised in this report to ensure that appropriate comprehensive assessment is undertaken of all proposed residents. Standard 6 refers to a service not provided at Walmer House. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 The care plans at the home lacked detail and did not include all the needs of a resident. Health needs were met appropriately. Service users were able to self medicate, but the risk assessment process was not in place to ensure they were safe. The administration medication records maintained by the home were incomplete and had the potential to put residents at risk. Residents were treated with respect and care was taken to ensure their privacy was maintained. EVIDENCE: The service user plans in the home are constructed from the information in the assessments and therefore the deficits have been duplicated. Given this position the care plan did not provide an appropriate foundation for the care to be provided to the individual resident and a requirement has been raised to ensure this is addressed. Health needs were assessed in detail and two district nursing teams were consulted as part of the inspection process. They advised that they did not have any concerns about the quality of the care provided at Walmer House and one team was particularly complimentary about the proposed registered
Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 11 manager who they said was very caring and followed their advice and suggestions. Residents were able to self medicate at the home; this should have been undertaken subject to a risk assessment to ensure they had the capacity and would be safe. The risk assessments were missing at the time of the inspection and a requirement has been raised to ensure they are undertaken without delay to ensure residents safety. The medication administration records maintained by the home had substantial deficits in the issue record and this has the potential to put residents at risk. A requirement has been raised to ensure that all staff adheres to the homes policy and procedure for the administration of medication. It is acknowledged that the recording of medication being checked and booked in when received and the record of the returns of unused medication were complete. Medication was securely stored at the home. It has been discussed and agreed with the management team at the home that a visit from the pharmacy inspector would be helpful and this is being arranged. Six residents were asked for their views of how they were treated at the home this was undertaken individually in private. They all confirmed that they were always treated with respect and that their privacy was paid due regard by their carers. Carers were seen to knock on the door before entering a resident’s own room. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Service users at the home enjoyed the lifestyle provided and were able to receive their visitors at anytime and their movements were unrestricted. Assistance was provided to enable residents to exercise control over their lives. Residents receive a varied, appealing, wholesome and nutritious diet and meals were taken in a well appointed dedicated dining room. EVIDENCE: Six residents were consulted individually in private, they advised that they liked the lifestyle at the home and felt that they had enough activities available and did not want to suggest any additions. They also stated that the routines of the home took place around their needs and that these routines could be altered to suite a service users wishes if desired. Residents said that they felt in control of their lives and felt they were consulted about matters that affected them. One resident remarked, “Life is good here and I like the new manager” another stated “ I always feel I can get help if I need it “. The home has a clear unrestricted policy on visiting; all the service users consulted confirmed that this was the case and that their visitors were always made welcome. Visitors were able to share a meal with their relative at the home and persons who had travelled a long distance could be accommodated overnight when the home had room, a charge was made for this extra service.
Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 13 All the service users consulted at the time of the inspection confirmed that the food provided at the home was to their liking and that the portions were adequate. Choice was always available and residents said they liked the arrangements in the dining room. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Residents were confident that any issue they raised would be taken seriously and resolved for them. The home has an appropriate adult protection policy and procedure in place but staff training is outstanding. EVIDENCE: The home has available a detailed complaints procedure, the residents consulted on the day of the inspection were unaware of what it was. However, they were confident that if they raised an issue with the management of the home it would be resolved quickly for them. This position was discussed with the management of the home and it was agreed that residents would have a copy of the home’s complaints procedure provided to them individually. The home does have an appropriate adult protection policy that meets the current legislation. However, it was understood that the training for carers is still outstanding; this should be given more priority and be undertaken without further delay. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Residents at Walmer House live in a safe, well-maintained environment that is clean, pleasant and hygienic. EVIDENCE: Walmer House provides a comfortable, safe environment for the people who live there. The home has a running maintenance programme and redecoration is undertaken as required. All the residents consulted on the day of the inspection advised that they liked their rooms “very much”. All the toilets and bathrooms were seen and were generally well equipped, however in one of the shower rooms a resin garden chair was found which is inappropriate as they are known to facture and would therefore put the resident at risk. There was also a pair of Wellingtons and a large overall, which was understood at the time of the inspection not to be used. This inappropriate and redundant equipment should be removed without delay. These items have been seen before and it has been agreed that they would be removed but this has not happened.
Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 16 A complete tour of the home was undertaken and high standards of hygiene were evident throughout. No malodour was found and residents said the home was always very well kept. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 There are always sufficient numbers of staff on duty to meet residents’ needs but the home does not have a stable well-trained staff group available. Some carers do not follow the policy and procedures of the home and consequently residents can be at risk. Residents were not appropriately protected by the home recruitment practices. Staff training was outstanding. EVIDENCE: The home continues to have deficits in the care team. Currently the care team at the home consist of two full time carers and one part time plus the proposed registered manager, this is during the day. The home’s staff covers all weeknights with some support needed by agency carers at weekends. At the time of the inspection the proposed registered manager and the operations controller stated that when they had seen care staff not following the homes policy and procedures they had corrected them but this did not have a lasting affect. Clearly this is a management issue for the home and the Keychange Charity but there should be a consequence if the policies and procedures in place are not followed particularly when they put residents at risk. The care team at the home must be trained and competent to fulfil their role. Residents consulted during the inspection advised that they were well cared for at the home and felt that they could rely on the staff team for assistance at anytime.
Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 18 Deficits were found in the personnel files of carers at the home, references were missing which has the potential to put residents at risk. A requirement has been raised in this report to ensure that this is rectified without delay. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38 Currently the management of Walmer House has substantial deficits. Residents’ financial interests are safeguarded. The health and safety of residents and staff is promoted but not sufficiently well enforced. EVIDENCE: The proposed registered manager has 10.5 years experience in care and has completed a probationary period at the home. At the time of the inspection she stated that she had only received two days induction from the operations manager and two one day training visits to the head office of the charity. She went on to say that she was unaware of some of the detail of the National Minimum Standards and did not have a copy available for sometime when she took up the post and recently has been spending a large part of her week covering care hours. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 20 It was understood that the operations manager visited the home two or three times a week. The home assist some residents with the administration of their pocket money, three sets of records were checked and all monies counted these were all correct in every respect. Receipts are retained for any purchase undertaken by the home on behalf of a resident. Health and safety issues were apparent during the inspection, risk assessments were missing and carers were not following the policies and procedures, requirements have been raised to ensure that these matters are rectified. The fire precautions undertaken by the home were examined and found to be appropriate and up to date, the electrical appliances were checked and the installation of electricity at the home had a current certificate at the time of the inspection. The vertical lift and other aids used throughout the home were appropriately serviced which ensured that residents were safe. Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 2 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 3 x x 2 Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The registgered provider must ensure that an assessment is undertaken of all the needs of a prospective resident. The registered provider must ensure that the service users health, personal and social care needs are set out iin an individual plan of care. The registered provider must ensure that all staff adhere to the policy and procedure for the correct administration of medication. The registered provider must ensure that quality assurance sytems are in place to check that carers are following the polices and procedures in the home. The registered provider must ensure that all care staff have formal supervision at least 6 times per year The registered provider must ensure that the documents called for in Schedule 2 are in place for each person working at the care home. The registered provider must give notice to the Commission without delay of the occurance
D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Timescale for action 16/03/06 2. OP7 15 30/03.06 3. OP9 13 03/02/06 4. OP33 13 02/03/06 5. OP36 18 02/03/06 6. OP29 19 02/03/06 7. OP38 37 03/02/06 Walmer House Version 1.40 Page 23 8. OP30 18 of:(a) The death of any service user, including the circumstances of his death. (b) The outbreak in the home of any infectious desease. (c) Any serious injury to a service user. (d) The serious illness of a service user in a care home at which nursing is not provided. (e) Any event in a care home that adversely affects the well-being or safety of any service user. (f) Any theft, burglary or accident in the care home. (g) Any allegation of misconduct by the registered person or any person who works at the care home. Any notification made in accordance with this regulation which is given orally shall be confirmed in writing. The registered provider must 02/03/06 ensure that staff are trained and competent to do their jobs. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Walmer House D54-D07 S18447 Walmer House V231761 300805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton Devon, TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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